title: Clinical indications and results after chest wall resection for recurrent mesothelioma.
abstract: OBJECTIVE
  The ipsilateral hemithorax is the most common site of recurrence after surgical resection for malignant pleural mesothelioma. Salvage treatment has generally been ineffective. We reviewed the outcomes after resection of isolated ipsilateral chest recurrence after cytoreductive surgery in patients with malignant pleural mesothelioma.
  
  
  METHODS
  Patients with malignant pleural mesothelioma who underwent initial surgical resection at our institution from 1988 to 2011 and were subsequently treated for localized recurrence with an additional chest resection were identified and their data retrospectively reviewed.
  
  
  RESULTS
  A total of 1142 patients underwent either extrapleural pneumonectomy (n = 794) or pleurectomy/decortication (n = 348). Of the patients who returned for follow-up, 47 (4.1%) had chest wall recurrence amenable to resection. The location of recurrence was predominantly incisional (49%) and/or costophrenic (38%). The median time to recurrence after either extrapleural pneumonectomy or pleurectomy/decortication was 16.1 months (range, 2.7-58.2). No 30-day mortality was found for chest wall resection, and the median length of stay in the hospital was 3 days (range, 0-12). The median overall survival duration after chest wall resection correlated positively with the time to recurrence (epithelial: median, 8.9, 17.2, and 35.8 months for a time to recurrence of <12, 12 to <24, and ≥24 months, respectively; biphasic: median, 2.7 and 15.9 months for a time to recurrence of <10 and ≥10 months, respectively).
  
  
  CONCLUSIONS
  Chest wall resection is a safe and effective therapeutic option in the management of localized chest wall recurrence of malignant pleural mesothelioma. The time to recurrence appears to be predictive of the expected survival benefit in both epithelial and biphasic malignant pleural mesothelioma.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University Medical School, Stanford, Calif.
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Burt
authors.forename: Syed O
authors.initials: SO
authors.lastname: Ali
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: DaSilva
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: William G
authors.initials: WG
authors.lastname: Richards
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.forename: David J
authors.initials: DJ
authors.lastname: Sugarbaker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011013:Pneumonectomy; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: 14; 5; CT; CWR; EPP; MPM; PD; TTR; chest wall resection; computed tomography; extrapleural pneumonectomy; malignant pleural mesothelioma; pleurectomy/decortication; time to recurrence